title: Efficacy of lamivudine combined with adefovir dipivoxil versus entecavir monotherapy in patients with hepatitis B-associated decompensated cirrhosis: A meta-analysis.
abstract: Whether the combination of lamivudine (LAM) plus adefovir (ADV) de novo is more effective than entecavir (ETV) monotherapy in patients with HBV-associated decompensated cirrhosis is still controversial. We searched seven randomized controlled trials that included 411 patients in this meta-analysis. There are 205 and 206 patients in these two groups separately. The pooled risk ratio (RR) and mean difference (MD) were used to assess the treatment effects. ETV monotherapy significantly improved Child-Turcotte-Pugh (CTP) scores (MD = 0.33, 95%CI [0.21-0.44], P < .00001), and was associated with lower rates of serum creatinine increase compared LAM + ADV combination therapy (RR = 4.76, 95%CI [1.11-20.33], P = .04) at 48 weeks. The reduction of alanine aminotransferase (ALT) levels, HBV DNA levels, the rate of ALT normalization, undetectable HBV DNA, HBV e antigen (HBeAg) loss, HBeAg seroconversion and mortality were similar between the two groups. ETV is more effective than LAM + ADV in improving CTP scores at 48 weeks. Both of the LAM + ADV and ETV had similar efficacy in improving virological and biochemical parameters at 48 weeks of follow-up. Furthermore, use of these agents in decompensated HBV patients was generally safe and well tolerated at 48 weeks. However, the nephrotoxicity of ADV, and the potential adverse effects of ETV should be considered and monitored during prolonged therapy.
authors.affiliation: Department of Infectious Diseases, Institute for Viral Hepatitis, Key Laboratory of Molecular Biology for Infectious Diseases, Ministry of Education, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
authors.forename: Hong
authors.initials: H
authors.lastname: Peng
authors.forename: Junying
authors.initials: J
authors.lastname: Liu
authors.forename: Min
authors.initials: M
authors.lastname: Yang
authors.forename: Shiwen
authors.initials: S
authors.lastname: Tong
authors.forename: Wenwei
authors.initials: W
authors.lastname: Yin
authors.forename: Hui
authors.initials: H
authors.lastname: Tang
authors.forename: Peng
authors.initials: P
authors.lastname: Hu
authors.forename: Huaidong
authors.initials: H
authors.lastname: Hu
authors.forename: Hong
authors.initials: H
authors.lastname: Ren
mesh_terms: D000225:Adenine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000410:Alanine Transaminase / Q000097:blood; D000998:Antiviral Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D003404:Creatinine / Q000097:blood; D004279:DNA, Viral / Q000097:blood; D004359:Drug Therapy, Combination; D005260:Female; D006147:Guanine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D019694:Hepatitis B, Chronic / Q000097:blood / Q000150:complications* / Q000188:drug therapy* / Q000401:mortality / Q000821:virology; D006801:Humans; D019259:Lamivudine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008103:Liver Cirrhosis / Q000097:blood / Q000150:complications* / Q000188:drug therapy / Q000401:mortality / Q000821:virology; D008297:Male; D008875:Middle Aged; D063065:Organophosphonates / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D063065:Organophosphonates; D019259:Lamivudine; C413685:entecavir; D006147:Guanine; D003404:Creatinine; D000410:Alanine Transaminase; D000225:Adenine; C106812:adefovir dipivoxil
keywords: chronic hepatitis B-associated decompensated cirrhosis; enticavir; lamivudine plus adefovir dipivoxil; meta-analysis